Healthcare Provider Details

I. General information

NPI: 1902883168
Provider Name (Legal Business Name): SENDHIL K SUBRAMANIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 PEACHTREE DUNWOODY RD STE 370
ATLANTA GA
30342-1713
US

IV. Provider business mailing address

1830 COLLAND DR NW
ATLANTA GA
30318-2604
US

V. Phone/Fax

Practice location:
  • Phone: 678-447-0616
  • Fax: 833-450-0491
Mailing address:
  • Phone: 678-468-0419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number049107
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: